2 The Use of WAIS-III in HFA and Asperger Syndrome

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1 2 The Use of WAIS-III in HFA and Asperger Syndrome Published in: Journal of Autism and Developmental Disorders, 2008, 38 (4),

2 Chapter 2 Abstract The WAIS III was administered to 16 adults with the autistic disorder and 27 adults with Asperger syndrome. Differences between Verbal Intelligence (VIQ) and Performance Intelligence (PIQ) were not found. Processing Speed impairment was observed in the participants with the autistic disorder. At the subtest level, the Asperger syndrome group performed weak on Digit Span. Strengths were found on the subtests Comprehension and Block Design. In the autistic disorder group, performance on Digit-Symbol Coding and Symbol Search was relatively poor. Strengths were found on Information and Matrix Reasoning. The results suggest that the VIQ-PIQ difference cannot distinguish between the autistic disorder and Asperger syndrome. WAIS III Factor Scale and Subtest patterning provides a more valid indicator. 10

3 WAIS-III 2.1 Introduction Over the past few years, interest in HFA and Asperger syndrome in adults with normal intelligence has increased markedly. However, not much is known about the cognitive profiles of these groups. Only a few studies exist about adults who function relatively well in society and have been diagnosed late in life (Howlin, 2004; Vermeulen, 2002). The present study aims to assess the cognitive profiles of this relatively high-functioning subgroup by means of the Wechsler Intelligence Scale III (WAIS III, Wechsler, 1997). In WAIS III, the intelligence pattern is described at three levels: The first level contains Performance Intelligence and Verbal Intelligence. The second level consists of the four factor scales: Verbal Comprehension, Perceptual Organization, Freedom from Distractibility and Processing Speed. The third level contains the subtests. The following paragraphs summarizes previous research results of the intelligence profiles adults with the autistic disorder and Asperger syndrome on these three levels. The Performance IQ (PIQ) - Verbal IQ (VIQ) dichotomy has been previously used incorrectly to underpin the diagnosis of autistic disorder and Asperger syndrome. It is questionable whether the two constructs should even be applied in general, because research did not support the construct validity of the VIQ-PIQ dichotomy (Taub, 2001). Studies examining WAIS-R in adults with HFA have yielded contradictory results (Minshew et al. 1992; Siegel et al., 1996; Vermeulen, 2002), which may reflect the validity problems of the VIQ-PIQ dichotomy (Arnau & Thompson, 2000; Taub, 2001). The factor scale level is of great importance in assessing cognitive abilities, sinceactor analytic studies indicate that they give the best estimates of the four factors underlying intelligence (Arnau & Thompson, 2000; Ryan & Paolo, 2001). No studies have investigated the WAIS-III profiles for adults with HFA and Asperger syndrome, as far as we know. Therefore we have no information about the factor scale profiles in these groups. This leads to the conclusion that the most important factors of the intelligence patterns for adults with HFA and Asperger syndrome are still unknown. At subtest level, some studies on WAIS or WAIS-R reported low Comprehension versus high Block Design scores (Goldstein et al., 2001; Rumsey & Hamburger, 1988). A relatively high variability between the subtests scores in adults with HFA has also been reported (Siegel et al., 1996). In summary, research shows that among adults with HFA and Asperger syndrome, results of VIQ-PIQ differences vary and may be influenced by the validity problems of the VIQ-PIQ dichotomy. The factor scale scores and the subtest patterns provide a better 11

4 Chapter 2 representation of the intelligence pattern but these are still unknown in adults with HFA and Asperger syndrome Aims of the Present Study The present study aims to acquire insight into the WAIS III profiles of normal intelligent adults with HFA and Asperger syndrome. Profiles in the total group and differences between the two diagnostic groups will be examined. 2.2 Methods Procedure All participants were recruited from the GGZ (Mental Health Center) Eindhoven and Oost- Brabant. The participants met the criteria for Asperger syndrome or HFA. Participants with relevant neurodevelopmental conditions and genetic conditions were excluded, as were institutionalized patients and patients with a Full Scale IQ below Subjects The mean Full Scale IQ of the participants was , individual scores varied between 83 and 145 (see table 1). 12

5 WAIS-III Table 1 Characteristics of Participants IQ and age M SD Range Full scale IQ Mean age Diagnosis f P Autistic disorder Asperger syndrome Gender Male Female Education Lower / middle education Higher education Employment status Employed or retired Studying Unemployed Current living circumstances Lives with partner Lives independently Sheltered living Lives with parents All individuals ranged in age from 18 to 60 years. The mean age was Of all participants, 25 finished higher education and 30 individuals had work. 23 participants lived together with a partner. The relatively large number of participants who had a relationship, worked and were well educated emphasizes the relatively high level of functioning in this group Assessment of Disorder Hetero-anamnestic information was gathered using the Dutch version of the Autistic Disorder Diagnostic Interview, revised version (ADI-R, Lord et al., 1994), administered by psychologists who were officially trained in the administration and scoring of the 13

6 Chapter 2 instrument. To gather anamnestic information, a semi-structured interview was used to assess presence of the DSM-IV criteria of HFA and Asperger syndrome (APA, 1994). Because of the controversial nature of the DSM-IV criteria (Ghaziuddin et al., 1992; Mayes et al., 2001), additional questions were used to differentiate between HFA and Asperger syndrome, based on the diagnostic criteria of Gillberg & Gillberg (1989) and ICD-10 (WHO, 1993) Assessment of Intelligence The intelligence profile was assessed using the Dutch translation of the WAIS III (Wechsler, 1997). The WAIS-III has excellent psychometric properties (Sattler & Ryan, 1999) and has been validated for the Dutch population (Wechsler, 1997). 2.3 Results Analyses were performed at the three WAIS-III levels: VIQ versus PIQ, the four factor scales and all subtests. Preliminary analysis included checks for normality, linearity, influential data points and assumptions of repeated measures. No serious deviations were found. T-tests showed that both diagnosis groups were comparable in education, work status and gender distribution Differences Between WAIS III VIQ and PIQ Differences between VIQ and PIQ for the total group and for the two diagnostic groups were analyzed by means of paired t-tests. No statistically significant effects were found for any of the groups (see table 2). Table 2 VIQ and PIQ Differences in the Total Group and in Diagnostic Groups VIQ PIQ M SD M SD mean diff. n Total group Asperger Autism

7 WAIS-III Differences Between Factor Scale Scores Factor Scale profiles were studied within the total group and between the two diagnostic subgroups by means of repeated measures analysis of variance. Mauchly's test indicated that the assumption of sphericity was not met. Therefore the degrees of freedom were corrected using the Huynh-Feldt correction ( =.89). Post-hoc comparisons using the Sidak adjustment for multiple comparisons showed that the main effect of the WAIS III Factor Scale was statistically significant (F(2.7,109.7)=7.0, p<0.001). An interaction effect of differences in Factor Scale mean by diagnostic group was also found (F(2.7, 109.7)=2.7, p=0.05). To find out which differences in WAIS III Factor Scale means added to the significant main effect, post hoc pairwise comparisons were done. This showed that the main effect in the total group can be attributed to Processing Speed being significantly lower than Verbal Comprehension (p <.01) and Perceptual Organization (p <.005). Post hoc pairwise comparisons were done for the two diagnostic groups to analyse the within group effect. In the Asperger group, no significant differences in Factor Scale mean scores were found. The HFA group however, showed a significant lower Processing Speed compared to Verbal Comprehension (p <.01), Perceptual Organization (p <.01) and Freedom from Distractibility (p <.05) (see table 3). 15

8 Chapter 2 Table 3 Factor Scale Scores for the Total Group and the Diagnostic Groups Factor Scale M SD n Verbal Comprehension Autistic disorder 107.5* Asperger syndrome Total 109.6* Perceptual Organization Autistic disorder 105.0* Asperger syndrome Total 109.3* Freedom from Distractibility Autistic disorder 105.1* Asperger syndrome Total Processing Speed Autistic disorder 91.8* Asperger syndrome Total 101.0* * p < Differences Between WAIS III Subtest Scores The Subtest profiles were explored within the total group and between the two diagnostic subgroups by means of a repeated measures analysis of variance. The assumption of sphericity was not met. Therefore the degrees of freedom were corrected using the Huynh-Feldt correction ( =.82). Post-hoc comparisons were performed using the Sidak adjustment for multiple comparisons. The results (see table 4) showed a significant main effect of the type of Subtest (F(10.7,438.7)=4.8, p<0.001). 16

9 WAIS-III Table 4 Mean Standardized Subtest Scores for the Total Group Subtest Scores M SD n Vocabulary 11.63* Similarities Arithmetic 11.77* Digit Span Information 12.42* Comprehension 12.53* Letter-Number Sequencing Picture Completion Digit-Symbol Coding 9.81* Block Design 12.02* Matrix Reasoning 11.98* Picture Arrangement Symbol Search 10.37* Object Assembly * p <.05. An interaction effect of Subtest by diagnosis was also found (F(10.7, 438.7)=2.1, p<0.05), indicating that the patterning of the WAIS III subtest mean scores for the two diagnostic groups differs. Table 5 and 6 show the mean Subtest scores and standard deviations for the HFA group and the Asperger syndrome group. 17

10 Chapter 2 Table 5 Mean Standardized Subtest Scores for the Autistic Disorder Group Subtest Scores M SD n Vocabulary Similarities Arithmetic Digit Span Information 12.13* Comprehension Letter-Number Sequencing Picture Completion Digit-Symbol Coding 8.38* Block Design Matrix Reasoning 11.44* Picture Arrangement Symbol Search 8.44* Object Assembly * p <

11 WAIS-III Table 6 Mean Standardized Subtest Scores for the Asperger Syndrome Group Subtest Scores M SD n Vocabulary Similarities Arithmetic Digit Span 10.37* Information Comprehension 13.00* Letter-Number Sequencing Picture Completion Digit-Symbol Coding Block Design 12.89* Matrix Reasoning Picture Arrangement Symbol Search Object Assembly * p <.05. Post hoc pair wise comparisons showed that the main effect in the total group can be attributed to the fact that Digit-Symbol Coding was significantly lower than Vocabulary (p <.05), Arithmetic (p <.05), Information (p <.005), Comprehension (p <.005), Block Design (p <.05) and Matrix Reasoning (p <.005). Furthermore, Symbol Search was lower than Information (p <.05) and Comprehension (p <.05). Post hoc pair-wise comparisons were also performed for the two diagnostic groups to analyze the within group effect. The two groups showed significant differences in Subtest scores. In the Asperger syndrome group, Digit Span was lower than Comprehension (p =.005) and Block Design (p <.05). In the HFA group performance was significantly higher in Information compared to Digitsymbol Coding (p <.05) and Symbol Search (p <.05). Furthermore, Digit-Symbol Coding was lower than Matrix Reasoning (p <.05). 19

12 Chapter Discussion WAIS VIQ Versus PIQ No significant differences were found between VIQ and PIQ in the total group nor in the two diagnostic subgroups. The results are in line with factor analytic studies which showed that the VIQ-PIQ dichotomy is not valid for general populations (Arnau & Thompson, 2000; Taub, 2001) WAIS III Factor Scale Level The Asperger syndrome group was characterized by a flat Factor Scale profile in the Asperger syndrome group, while the HFA group performed significant low in Processing Speed. A low Processing Speed indicates problems in speed of processing visual information (Wechsler, 1997). Adults with HFA apparently need more time than other people to process and integrate visual information and to act on this information. The Processing Speed performance of the HFA group might be influenced by problems with top-down processing and ignoring irrelevant details, which are characteristic of people with HFA (Happé, 2005; Shah & Frith, 1993). In order to maintain an overview of what they are doing, they work slowly WAIS III Subtest Level Analyses showed different Subtest patterns in the HFA and the Asperger syndrome groups. The HFA group performed significantly poor in Digit-Symbol Coding and Symbol Search. These two subtests together form the Processing Speed Factor. The low scores for these subtests represent the problems in speed of processing visual information as described in the preceding paragraph. The HFA group showed significantly high performance in Information and Matrix Reasoning. High scores for Information are in line with the fact that people with autism usually acquire much factual knowledge (Happé, 1999). Matrix Reasoning taps nonverbal perceptual reasoning. Matrix Reasoning is the only Perceptual Organization subtest without a time limit and is possibly not influenced by low Processing Speed performance scores. The strengths of the HFA group in this subtest can probably be attributed to their visual-spatial strengths (Lincoln et al., 1995; Tsatsanis, 2005) and to the absence of a time limit for this subtest. 20

13 WAIS-III In the Asperger group, scores for Digit Span were relatively low. Digit Span taps working memory capabilities (Wechsler, 1997), which can been defined as the ability to hold in mind past states of the environment and past actions while currently performing an action (Russell, 1997). People with autism and Asperger syndrome tend to store information in details instead of using strategies, which often leads to problems in retaining information (Happé, 2005; Minshew et al., 1992; Tsatsanis, 2005). Low Digit Span scores in the Asperger group may reflect problems in applying strategies to retain information. The Asperger syndrome group performed significantly well on the subtest Comprehension. High scores on Comprehension in this group seem to contradict former research results (Klin et al., 2005b; Mayes & Calhoun, 2003; Siegel et al., 1996). However, people with Asperger syndrome often try to function in society by analyzing social situations at a cognitive level, which has been described as using an explicit theory of mind (Frith & Happé, 1999). An extremely well developed explicit theory of mind may have caused the strengths of the Asperger syndrome group on Comprehension. The Asperger Syndrome group also performed significantly well on Block Design. Qualities in Block Design have often been reported in studies of people with HFA and Asperger syndrome (Happé, 2005; Shah & Frith, 1993). This has been attributed to strengths in processing unconnected stimuli outside a meaningful context, which go together with the central coherence problems that are characteristic for people with autistic impairment (Shah & Frith, 1993) Conclusions The present study found participants with Asperger syndrome to differ significantly from individuals with HFA in WAIS III Factor Scale profiles and WAIS III Subtest patterning. In the individuals with HFA Processing Speed problems were found. Further, the HFA and Asperger syndrome group showed different subtest patterns. The present study supports the idea that HFA and Asperger syndrome can be differentiated empirically at the level of intellectual functioning. This lends support to the hypothesis that HFA and the Asperger syndrome are two separate disorders. 21

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